Benign lesions are the most common breast mass, occurring in 70% of biopsies/removals.
Consider the following parameters when a dominant mass has been palpated within the breast: age, physical characteristics of the mass and previous medical history. It is more common to find fibrocystic disease and fibroadenomas in younger women; older women are most likely to have intraductal papillomas, duct ectasia and caner.
Cysts…
Commonly seen in women 35-40 years of age Symptoms: · History of the cyst changing with the menstrual cycle · Pain (experienced when the cyst is growing rapidly) · Recent Lump & Tenderness
Types of complex cysts...
Galatocele – a milk filled cyst (see photo -> )
Typically located in below the areola
Caused by obstructed lactiferous duct
Sebaceous cyst
Caused by an obstructed sebaceous gland within the skin
* Photo: Complex mass, galactocele. Transverse sonogram of palpable mass occupying most of the breast obtained in a 18-year-old woman shows a complex cystic (C) and solid (S) mass. Aspiration was performed for symptomatic relief, yielding 250 mL of breast milk.
· Firm, smooth, rubbery or hard lump with a well-defined shape · Moves easily under your skin when touched and is usually painless · More common among women in their 20’s and 30’s · Range in size from less than 1 cm to several centimeters in diameter. · Treatment may include careful monitoring to detect changes in the size or feel of the fibroadenoma or surgery to remove it. · Do not change size during the menstrual cycle, but can get bigger during pregnancy and breast-feeding · Tend to grow very slowly · A sudden increase in size with acute pain = hemorrhagic cyst
FCC involves the glandular breast tissue. Estrogen and progesterone directly affect the breast tissues by causing cells to grow and multiply; which contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period. However, when the monthly cycle is over these stimulated breast cells cannot simply slough away and pass out of the body. Instead, many of these breast cells undergo death, called apoptosis. This leads to scarring (fibrosis) that damages the ducts and the lobules of glandular tissue within the breast causing “lumpy breasts.”
Sonographic Signs: round masses as multiple cysts
Lipoma
Pure Lipoma – consist entirely of fatty tissue
Other forms include fibrous and glandular elements within the fatty tissue
May grow quite large prior to detection
Usually middle aged or menopausal women
Clinical Palpation:
Large, soft, w/ irregular borders; connot be separated from surrounding breast tissue
Sonographically:
Very difficult or impossible to see
Typically smooth walls, hypoechoic - appears similar to fat
Poor enhancement
Compressible
Mastitis…yes an ‘itis’
· Inflammation of the mammary gland · Causes are infections and bacteria · Mostly occurs during lactation · Often confined to one area · Acute & Chronic classifications
Clinical signs:
· Pain, redness, and tenderness of the affected portion of gland · Abnormality of the milk (clots or flakes, and wateriness)
Abscess
· Hollow space in the breast that is filled with pus & surrounded by inflamed tissue · Often a complication of mastitis
Other causes:
· Mostly occur in breastfeeding women due to cracked nipples · overweight women w/ large breasts · poor personal hygiene · smoking
Sonographic Signs:
· Acute Abscess – poorly defined borders · Mature Abscess – well encapsulated, sharp borders **Color Doppler may be helpful in detecting increased vascularity
Diagnosis must be made upon aspiration, not on mammography alone
Clinical Signs: · Pain, swelling, reddening of skin · Axillary nodes may be swollen & painful
Cystosarcoma Phyllodes
Rare, predominantly benign
Comprises less than 1% of all breast neoplasms, yet it is the most frequent sarcoma of the breast
Usually unilateral
May arise from a fibroadenoma
Usually grows rapidly
27% are considered malignant; 12% metastisize
Clincal Signs
Deliniated, firm, mobile
Skin changes may develop caused by increasing pressure as the mass becomes lobulated and irregular
Edema may produce a skin change
As pressure increases it causes trophic changes and eventual skin ulcerations
Infection and abcess may be a secondary complication
Sonographic Signs
Large, hypoechoic tumor
Well defined margins
Decreased through-transmission
Internal echoes may be fine or course with variable amounts of shadowing
Intraductal Papilloma
Small, benign tumor
Grows within the acini of the breast
Occurs in women 35-55 years
Clinical Signs
Spontaneous nipple discharge arising from a single duct
When discharge is copious
usually preceeded by a sensation of fullness or pain in the areola area and is relieved when fluid is expelled
Has a "raspberry-like" configuration on the mammogram
May grow large in size and become palpable
Sonographic Signs
Usually small, multiple, and multicentric
Consist of simple perliferations of duct epithelium projecting outward into a dilated lumen from one or more focal points, each supported by a vascular stalk
Benign lesions are the most common breast mass, occurring in 70% of biopsies/removals.
Consider the following parameters when a dominant mass has been palpated within the breast: age, physical characteristics of the mass and previous medical history. It is more common to find fibrocystic disease and fibroadenomas in younger women; older women are most likely to have intraductal papillomas, duct ectasia and caner.
Cysts…
Commonly seen in women 35-40 years of age
Symptoms:
· History of the cyst changing with the menstrual cycle
· Pain (experienced when the cyst is growing rapidly)
· Recent Lump & Tenderness
Types of complex cysts...
* Photo: Complex mass, galactocele. Transverse sonogram of palpable mass occupying most of the breast obtained in a 18-year-old woman shows a complex cystic (C) and solid (S) mass. Aspiration was performed for symptomatic relief, yielding 250 mL of breast milk.
http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat2=11&cat3=407&cat4=1&stype=n
Fibroademoma… ~ Most common benign breast tumor~
· Firm, smooth, rubbery or hard lump with a well-defined shape
· Moves easily under your skin when touched and is usually painless
· More common among women in their 20’s and 30’s
· Range in size from less than 1 cm to several centimeters in diameter.
· Treatment may include careful monitoring to detect changes in the size or feel of the fibroadenoma or surgery to remove it.
· Do not change size during the menstrual cycle, but can get bigger during pregnancy and breast-feeding
· Tend to grow very slowly
· A sudden increase in size with acute pain = hemorrhagic cyst
Sonographic Signs:
· Smooth, rounded margins, low-level homogeneous internal echoes w/ possible posterior enhancement
Fibrocystic Condition (FCC) - AKA: Lumpy Breasts
FCC involves the glandular breast tissue. Estrogen and progesterone directly affect the breast tissues by causing cells to grow and multiply; which contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period.
However, when the monthly cycle is over these stimulated breast cells cannot simply slough away and pass out of the body. Instead, many of these breast cells undergo death, called apoptosis. This leads to scarring (fibrosis) that damages the ducts and the lobules of glandular tissue within the breast causing “lumpy breasts.”
Sonographic Signs: round masses as multiple cysts
Lipoma
Pure Lipoma – consist entirely of fatty tissue
Sonographically:
Mastitis… yes an ‘itis’
· Inflammation of the mammary gland
· Causes are infections and bacteria
· Mostly occurs during lactation
· Often confined to one area
· Acute & Chronic classifications
Clinical signs:
· Pain, redness, and tenderness of the affected portion of gland
· Abnormality of the milk (clots or flakes, and wateriness)
Abscess
· Hollow space in the breast that is filled with pus & surrounded by inflamed tissue
· Often a complication of mastitis
Other causes:
· Mostly occur in breastfeeding women due to cracked nipples
· overweight women w/ large breasts
· poor personal hygiene
· smoking
Sonographic Signs:
· Acute Abscess – poorly defined borders
· Mature Abscess – well encapsulated, sharp borders
**Color Doppler may be helpful in detecting increased vascularity
Diagnosis must be made upon aspiration, not on mammography alone
Clinical Signs:
· Pain, swelling, reddening of skin
· Axillary nodes may be swollen & painful
Cystosarcoma Phyllodes
Clincal Signs
Sonographic Signs
Intraductal Papilloma
Clinical Signs
Sonographic Signs